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Home Hospital for Suddenly Ill Adults

Home Hospital for Suddenly Ill Adults: A Clinical Trial

Who can join

As published by the study on ClinicalTrials.gov. "Not stated" means the study hasn't said — ask the study team.

Age
18 Years and older
Sex
All sexes
Healthy volunteers
Not accepted
Compensation
Not stated

Other requirements are listed under Eligibility below. Only the study team can confirm whether you can join.

What to expect

No one can promise a trial will help you personally — that is what the research is trying to find out.

What participation involves

  • Procedures mentioned: Blood draws, X-rays, Ultrasound

Only what the study's summary and detailed description on ClinicalTrials.gov say. Time periods may describe the whole study or a part of it — ask the study team what applies to you.

Show the study's own words
  • "The typical staff (medical doctor \[MD\], registered nurse \[RN\], case manager), diagnostics (blood tests, vital signs, telemetry, x-ray, and ultrasound), intravenous therapy, and oxygen/nebulizer therapy will all be available for home hospital."
Compensation
Not stated
  • Study-related exams and procedures are typically provided at no cost. This is how many trials work in general — confirm the details for this study with the study team.
  • Participants are monitored closely by the research team throughout the study.
  • Some participants may receive access to an investigational treatment, which is still being studied.
  • Your participation helps researchers learn whether this approach could help future patients.

About this study

In plain language

This study tests hospital-level care at home instead of in a hospital. It is for adults who need hospital care for certain illnesses and live near the emergency department.

The investigators propose a home hospital model of care that substitutes for treatment in an acute care hospital. Limited studies of the home hospital model have demonstrated that a sizeable proportion of acute care can be delivered in the home with equal quality and safety, reduced cost, and improved patient experience.

Compensation is read from the study's own description and may be missing — always confirm with the study team.

Eligibility

Who can join

  • You are at least 18 years old.
  • You live within 5 miles or a 20-minute drive of the emergency department.
  • You can agree to join the study, or you can give your agreement and have someone legally allowed to consent for you.
  • A caregiver agrees to stay with you for the first 24 hours, call the care team if needed, and check on you as needed after that. You and your clinician may skip this rule if you can safely manage your own care.
  • The emergency room team finds that you have or may have a qualifying condition: a skin infection, heart failure, a complex urinary infection, pneumonia, COPD (long-term lung disease), asthma, another infection, long-term kidney disease, cancer pain, diabetes or its complications, or a gout flare (painful joint swelling).
  • Other qualifying needs include very high blood pressure, a previously diagnosed irregular heartbeat that is now fast, blood-thinning treatment, or a wish for medical treatment only that requires a hospital stay. The emergency room team decides if you qualify.

Who can't join

  • You have no home, live in a place with on-site medical care, are in police custody, or a safety check finds signs of domestic violence.
  • Your home has no running water, no working heat from October through April, or no working air conditioning when temperatures above 80°F are forecast from June through September.
  • You take methadone that you must pick up each day.
  • You have sudden confusion on a screening test, or cannot walk to a bedside toilet on your own.
  • The emergency department cannot place an IV (a small tube in a vein), or needs ultrasound to place it.
  • You also have kidney failure at its final stage, a current heart attack, a current stroke, or sudden bleeding.
  • You need repeated or regular strong pain medicine through an IV, are at high risk of getting worse, or the doctor expects you to need a CT or MRI scan, a scope exam inside the body, a blood transfusion, a heart stress test, or surgery.
  • The home hospital program is full. It can care for no more than 5 patients at a time.

Simplified for readability. The official criteria below are what the study team uses.

Official eligibility criteria

Inclusion Criteria: * Resides within either a 5-mile or 20 minute driving radius of emergency department * Has capacity to consent to study OR can assent to study and has proxy who can consent * \>= 18 years-old * Can identify a potential caregiver who agrees to stay with patient for first 24 hours of admission. Caregiver must be competent to call care team if a problem is evident to her/him. After 24 hours, this caregiver should be available for as-needed spot checks on the patient. This criterion may be waived for highly competent patients at the patient and clinician's discretion. * Primary or possible diagnosis of cellulitis, heart failure, complicated urinary tract infection, pneumonia, COPD/asthma, other infection, chronic kidney disease, malignant pain, diabetes and its complications, gout flare, hypertensive urgency, previously diagnosed atrial fibrillation with rapid ventricular response, anticoagulation needs, or a patient who desires only medical management that requires inpatient admission, as determined by the emergency room team. Exclusion Criteria: * Undomiciled * No working heat (October-April), no working air conditioning if forecast \> 80°F (June-September), or no running water * On methadone requiring daily pickup of medication * In police custody * Resides in facility that provides on-site medical care (e.g., skilled nursing facility) * Domestic violence screen positive * Acute delirium, as determined by the Confusion Assessment Method * Cannot establish peripheral access in emergency department (or access requires ultrasound guidance) * Secondary condition: end-stage renal disease, acute myocardial infarction, acute cerebral vascular accident, acute hemorrhage * Primary diagnosis requires multiple or routine administrations of intravenous narcotics for pain control * Cannot independently ambulate to bedside commode * As deemed by on-call medical doctor, patient likely to require any of the following procedures: computed tomography, magnetic resonance imaging, endoscopic procedure, blood transfusion, cardiac stress test, or surgery * High risk for clinical deterioration * Home hospital census is full (maximum 5 patients at any time)

Study sites (2)

MA